European Heart Journal Advance Access originally published online on December 1, 2005
European Heart Journal 2006 27(5):553-561; doi:10.1093/eurheartj/ehi654
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Prospective assessment of integrating the existing emergency medical system with automated external defibrillators fully operated by volunteers and laypersons for out-of-hospital cardiac arrest: the Brescia Early Defibrillation Study (BEDS)
1Arrhythmias and Electrophysiology Center, Policlinico San Donato, University of Milan, ‘Via Morandi 30, 20097 San Donato Milanese, Milan, Italy
2Department of Cardiology, Spedali Civili, University of Brescia, Brescia, Italy
3Division of Emergency Medicine, Spedali Civili, Brescia, Italy
4Department of Cardiology, University of Washington, Seattle, WA, USA
Received 14 July 2005; revised 25 October 2005; accepted 27 October 2005; online publish-ahead-of-print 1 December 2005.
* Corresponding author. E-mail address: rcappato{at}libero.it
See page 508 for the editorial comment on this article (doi:10.1093/eurheartj/ehi704)
Aims There are few data on the outcomes of cardiac arrest (CA) victims when the defibrillation capability of broad rural and urban territories is fully operated by volunteers and laypersons.
Methods and results In this study, we investigated whether a programme based on diffuse deployment of automated external defibrillators (AEDs) operated by 2186 trained volunteers and laypersons across the County of Brescia, Italy (area: 4826 km2; population: 1 112 628), would safely and effectively impact the current survival among victims of out-of-hospital CA. Forty-nine AEDs were added to the former emergency medical system that uses manual EDs in the emergency department of 10 county hospitals and in five medically equipped ambulances. The primary endpoint was survival free of neurological impairment at 1-year follow-up. Data were analysed in 692 victims before and in 702 victims after the deployment of the AEDs. Survival increased from 0.9% (95% CI 0.4–1.8%) in the historical cohort to 3.0% (95% CI 1.7–4.3%) (P=0.0015), despite similar intervals from dispatch to arrival at the site of collapse [median (quartile range): 7 (4) min vs. 6 (6) min]. Increase of survival was noted both in the urban [from 1.4% (95% CI 0.4–3.4 %) to 4.0% (95% CI 2.0–6.9 %), P=0.024] and in the rural territory [from 0.5% (95% CI 0.1–1.6%) to 2.5% (95% CI 1.3–4.2%), P=0.013]. The additional costs per quality-adjusted life year saved amounted to 
39 388 (95% CI 16 731–49 329) during the start-up phase of the study and to 23 661 (95% CI 10 327–35 528) at steady state.
Conclusion Diffuse implementation of AEDs fully operated by trained volunteers and laypersons within a broad and unselected environment proved safe and was associated with a significantly higher long-term survival of CA victims.
Key Words: Out-of-hospital cardiac arrest • Early defibrillation • Automated external defibrillators
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- Automated external defibrillation in emergency medical systems: what has been achieved and where to go?
- Carsten W. Israel and Stefan H. Hohnloser
EHJ 2006 27: 508-509.[Extract] [Full Text]
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